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Inadequacy of IgM Antibody Tests for Diagnosis of Rocky Mountain Spotted Fever

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  • Rickettsial Zoonoses Branch, Division of Vectorborne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Tennessee Department of Health, Nashville, Tennessee

Among 13 suspected Rocky Mountain spotted fever (RMSF) cases identified through an enhanced surveillance program in Tennessee, antibodies to Rickettsia rickettsii were detected in 10 (77%) patients using a standard indirect immunofluorescent antibody (IFA) assay. Immunoglobulin M (IgM) antibodies were observed for 6 of 13 patients (46%) without a corresponding development of IgG, and for 3 of 10 patients (30%) at least 1 year post-onset. However, recent infection with a spotted fever group rickettsiae could not be confirmed for any patient, based on a lack of rising antibody titers in properly timed acute and convalescent serologic specimens, and negative findings by polymerase chain reaction testing. Case definitions used in national surveillance programs lack specificity and may capture cases that do not represent current rickettsial infections. Use of IgM antibodies should be reconsidered as a basis for diagnosis and public health reporting of RMSF and other spotted fever group rickettsiae in the United States.

Author Notes

* Address correspondence to Jennifer H. McQuiston, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop A30, Atlanta, GA 30333. E-mail: fzh7@cdc.gov

Authors' addresses: Jennifer H. McQuiston, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: fzh7@cdc.gov. Caleb Wiedeman, Emily Mosites, and Kevin Morris, Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, TN, E-mails: caleb.wiedeman@tn.gov, emily.mosites@gmail.com, and Kevin.Morris@tn.gov. Joseph Singleton, L. Rand Carpenter, Kristina McElroy, Ida Chung, and Cecilia Kato, Centers for Disease Control and Prevention, Rickettsial Zoonoses Branch, Atlanta, GA, E-mails: jsingleton@cdc.gov, r1carpenter@fastmail.fm, kristina.m.mcelroy2.civ@mail.mil, ipi8@cdc.gov, and hex0@cdc.gov. Abelardo C. Moncayo, Tennessee Department of Health, Vector-Borne Diseases Section, Communicable and Environmental Diseases Services, Nashville, TN, E-mail: Abelardo.Moncayo@tn.gov. Susan Porter and John Dunn, Tennessee Department of Health, Nashville, TN, E-mails: Susan.Porter@tn.gov and John.Dunn@tn.gov.

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